I had been undecided on this month’s topic until around 3 am one morning last week whilst lying awake in pain; mostly physical but also some emotional pain associated with the physical pain. We are, after all, a complete mind/body unit. It occurred to me then, as it often has, how many of us battle with pain of one sort or another.
A 2016 UK study found that approximately 8 million adults report chronic pain that is moderate to severely disabling. From the same report, it is estimated that 43% of adults (just under 28 million people) currently live with a degree of chronic pain. In older age groups this is even higher, with up to 62% of those aged 75 and over reporting chronic pain symptoms.
And yet we are generally at a loss to know how to deal with pain, other than simply trying to mask it with drugs.
Living with pain
Living with pain means living with it, not in spite of it, not battling with it, but being with our pain, whether that is physical, emotional, or mental pain. And eventually coming to terms with it, accepting it and making peace. Maybe even healing it.
The key word here is eventually. Using Mindfulness and meditation really works; it has dramatic effects, but it is a process. It takes time, commitment and perseverance. But aren’t you worth that time and effort?
I have split this topic into three separate blogs, so you can read all of them or just one without having to scroll through lots of text.
This first blog looks at pain and the science behind why and how mindfulness and meditation work.
The second blog focuses on my own process of using Mindfulness to learn to live with chronic pain and illness and includes some tips and techniques you may find helpful.
The third looks at living with a chronic condition or illness, whether that is depression, anxiety, an auto-immune condition, or any other long-term condition and includes a short meditation script for you to try.
Please feel free to share the scripts and suggestions, they are my own work and copyrighted to me and I give permission for them to be shared.
1 - How mindfulness / meditation works
There are many theories – here are just a few in brief:
1) gate control theory
This theory says that pain signals travel along nerves to the brain, force open the ‘gate’ (imagine it around the base of the skull) and cause us to feel the pain. When the pain signals are frequent the gate stays open and the pain becomes chronic. Of course, it’s a lot more complicated than this, but this is a useful simple model. We can close the gate in several ways, one of which is relaxation (a side-effect of meditation) and another is distraction. Using visualisations or body scans creates both distraction and relaxation.
2) choosing how to react to pain
A 2015 study found that all 38 participants in an MBSR course improved in both mental and physical function and continued to improve. The key was found to be a change in their approach to their pain: rather than viewing their conditions as something external happening to them which they had no control over, they began to feel in control over how they reacted to their pain. They realised they had a choice over how they let it make them feel.
3) physically reducing symptoms
Stress causes our pain response to become heightened: in a nutshell, stress hormones cause tension in the body and tension makes pain worse. By learning some simple breathing techniques (e.g. slowing the breath down, using a longer out-breath than in-breath to regulate the Oxygen and Carbon Dioxide levels in the blood and slow down the heart rate) and some relaxations, we can reduce stress and tension in the body. The more often we meditate, the more relaxed we become over time as we stimulate the Parasympathetic nervous system (the rest and relaxation response); whilst this system is stimulated the body cannot also stimulate the Sympathetic nervous system (which creates stress hormones – often termed the ‘fight/flight’ response).
More controversially, but gathering support as more research is completed, is the belief that we can heal our physical conditions with the mind. Research into the Placebo effect has shown that not only will a placebo drug stimulate the brain into releasing the proteins necessary for healing but using targeted visualisations can achieve the same result. (See Dr. David R. Hamilton)
So, how much and how often?
Original studies from Massachusetts University found measurable changes within 8 weeks of daily practice of around 40 mins per day. (See Jon Kabat Zinn, Dr. Sara Lazar and Dr. Herbert Benson)
Continuing studies using more sensitive equipment and smaller measures have found that just 6 weeks produces beneficial results.
The most recent studies suggest that just 15 minutes per day for 4 weeks reduces stress, increases happiness and boosts the immune system.
A 2017 eight-week trial by the BBC and the University of Westminster, for the programme Trust Me I’m A Doctor, showed it was better than gardening and yoga at helping people to relax.
All studies agree that the important thing is just to do it
Whether you are persuaded by science, spirituality or just desperation, try it. Even 5 minutes a day of mindful breathing will be more than you were doing before and will begin to de-stress your body.
Find an app, a book, an online tutorial, a guided meditation or a teacher-led course, obviously I would recommend the latter, but some people do find what they need online, and enjoy a new and exciting challenge which is both stimulating and healing.
2 – Living with pain and illness
The title of Vidyamala Burch’s book, Living Well with Pain and Illness, sums up this second blog in the series: living well.
Those of us with chronic or long-term conditions generally don’t want to spend our lives ‘battling with’, ‘fighting against’, ‘suffering’ or any other helpful terms we seem to get lumbered with. And yet these are the terms we hear and read all the time; even the well-meaning ‘you’re coping so well,’ seems limiting. Is my life now reduced to coping?
All this terminology is negative, aggressive or submissive, hardly the environment in which to enjoy a fulfilling life.
So how do we change this? Well, as usual, change starts with ourselves. By changing how we relate to our condition we change the effect it has on us. This isn’t easy or quick, like anything worthwhile it takes work, and I am not claiming that meditating every day will mean you can avoid any discomfort for the rest of your life. I wouldn’t like you to get the false impression that I spend every day floating around in zen-like serenity either. I have a family, work, real life and chronic illness. But I have tools.
So here are some of the stages of living with chronic illness based on my own experience and the work of people such as Burch, J K Zinn, Dr. David Hamilton, Sharon Salzberg and others.
Stage 1 – Acceptance
Whenever I talk about this in groups I always feel a shudder go through the room. We have a resistance to accepting that we are ill, maybe admitting there is an illness will be negative and we need to keep positive to get well. It’s true, we do need to keep positive but that doesn’t mean pretending that things are different from reality.
Acceptance isn’t about giving up, nor is it a ‘grin and bear it’ mindset and it has its own stages. For me acceptance meant working through denial, anger, frustration and blame until I finally realised that wishing things were different or that someone would magic everything better wasn’t helping. I had to learn to deal with what was. I had to turn towards my pain, recognise it and stop fighting it because when we fight ourselves we can only lose.
Nor is acceptance a one-off activity. My experience (and that of many others I have spoken to) is that after this initial acceptance comes a pattern of daily acceptance. Waking each day to pain and physical limitations means going through this process every morning, but I have learned that I have two choices: I accept the way things are and work with them (much more pleasant) or I stay angry, sad and frustrated (not pleasant at all).
Mental noting exercises can be very useful here, just noticing non-judgmentally how you feel about your pain or illness as well as noticing the way your body feels. Mindful breathing including the three-minute breath and awareness breathing can be very helpful in acknowledging where we are each day or in each part of the day. Are we pushing ourselves too much? Avoiding acceptance and storing up problems for later? Do we need rest?
Stage 2 – Letting go
Once we have accepted the way things are we have to let go of the way we think things should be or were going to be before we got ill. We go through a period of bereavement, sorrow at our lost future – and we need to let go of those negative feelings that crop up every day.
Human beings like the security of ‘knowing’ what the future will be like. we make plans about our jobs, families, relationships, holidays and so on. When chronic illness arrives (not planned) this throws a huge spanner in the planning area of the brain. The future is uncertain, even today is uncertain.
So we learn to let go of the need for certainty. This is scary and in my own meditation practice I literally visualised myself jumping off cliffs and into deep ravines until I had overcome the fear of not knowing. I completed lots of Hot Air Balloon meditations and similar; anything where I could visualise letting go of negative feelings and fear about the future until gradually the word ‘fear’ came up less and less in my consciousness. It still appears from time to time but I am able to accept the fear and then let it go, breathe it out, and so prevent being drawn into that feeling and being stuck with all the negative thoughts and worries that accompany it.
The decision to give up my career in teaching was difficult, I had worked hard to achieve what I had but it was no longer right for me. I hoped that as this door closed another would open. I was wrong. So many doors opened that I was overwhelmed for a while, suddenly life was opening up to me with opportunities I had never imagined were there. And I found that letting go of the idea of what I ‘should’ be doing, or ‘needed’ to do had allowed me to find where I am meant to be.
Stage 3 –Compassion, Kindness and Gratitude
The next stage I moved onto is where I am now: self-care. This stage is a mixture of the above. I learned to be compassionate with myself, to treat myself with the same level of kindness I would treat a child or someone who needed my care, or quite frankly any other human being would have had more kindness from me than I had been showing myself.
I complete regular compassionate body scans, I breathe kindness into my body and remember that it is doing the best it can. I stop myself when I feel like berating my body for being too slow or too painful remembering that I am just wishing things were different. Things are the way they are and wishing will not change that, just throw into larger relief the shadows of the monster I am hiding from.
Gratitude has become a major part of my ability to live well. When I was lying in bed, unable to see to read, worrying about the side-effects of the medication I was on and only the radio for company, I heard an interview with a woman in Syria explaining how it was impossible to get basic medication. People were suffering not just from the obvious effects of war but from their long-term conditions which had previously been managed but were now crippling them with pain, people losing their eyesight because they couldn’t get access to the medication I was complaining about having to take.
I pictured myself in my comfortable bed with clean sheets, access to a bathroom with running water, all the medication I needed, nutritious food and hot drinks brought to me and realised I had no right to feel sorry for myself. I realised two things then: everyone carries a burden – this is mine and I can choose how heavy or light I want to make it. Secondly, I don’t carry it alone and I have much to be grateful for. Now I am grateful every time I make a cup of tea because there have been many occasions when that was not possible.
Regular Loving Kindness Meditations, Compassionate and Gratitude body scans, and using mantras and affirmations have become part of my daily practice. These help us feel less pain, and the pain we are aware of reminds us of the need for self-care.
So, practice loving yourself. Consider what you would say to a best friend in your position and whether you need to change the way you talk to yourself. Picture yourself as a mountain, able to withstand whatever changes the weather throws at you, feel yourself rooted deep in the earth and reaching up into the clear air of the sky remembering that it is ok to just be.
3) Long-term illness and pain
This is the last of my three February Blogs and I have just got it posted in time!
This two-part blog briefly looks at some of the ways we typically approach a diagnosis of long-term illness and part two contains some exercises you can try. Using mindfulness, or any other form of meditation and associated philosophy, is not a quick-fix solution. It is about collecting the tools needed and then using them regularly to keep yourself in good running order remembering that you are being the best you can be in this moment.
Being diagnosed with a chronic illness:
Day one – relief
Relief, sometimes elation. For most people the diagnosis is initially a wonderful moment – you have been ill for a long time, you have probably been told it is all in your head and you have asked yourself continually why you can’t just feel well. You’ve tried ignoring your symptoms and telling yourself to ‘just get on with it’ except that has always made you more ill. Now someone has just affirmed that you are not imagining, you are not faking, and you are not attention seeking. It even has a name and suddenly it all makes sense. You probably leave the appointment on a high because now you can just say ‘I have...’ and no more explanation is needed.
Day two – back to earth
This may happen soon after diagnosis or some time later, but at some point you probably hit rock-bottom when you realised that this condition has little or no treatment and no cure. I remember experiencing this as a kind of yo-yo; going from relief through acceptance to fear and avoidance and back again for several months. This stage can last a long time, sometimes years, and includes some very dark moments which can unfortunately re-appear at any point. This is normal; however, we can still choose how we respond to these moments. Responding, rather than reacting, helps us control our actions and our thoughts.
The following years – ‘weaving your parachute’
After elation, depression, anger, denial and eventual acceptance comes the hard work of learning how to live with the ‘new’ you. This version of you really needs that tool box to be well stocked with good quality equipment. You won’t return to the old you, but that may not be so bad.
So, after waking up in the night and deciding to write this blog, did I get back to sleep? Yes, I did. And I used time awake constructively. Every time my mind wandered to wishing things were different, or catastrophising about the future, I used mindfulness to bring it back to the present. I recognised some useful insights into how past experiences have led me to view my illness and which areas still need work.
Do I wish the pain would go away? That I could magically recover and not have to face any of the possible futures this condition could offer? Yes, I do. But I also realise that wishing things were different is futile. I have a finite amount of energy and need to use it more productively.
Is it easy? No. Simple yes, but not easy. It takes practise and perseverance. But it works, and the only side effect is happiness (see Dr David R. Hamilton) unlike medication, which I also use but manage to keep the dosage down to the minimum.
Like any other important relationship, your relationship with yourself needs daily attention, self-care. I forgot this for a while and allowed my meditation practice to become a lower priority than my job and it was almost too late when I realised. As Jon Kabat Zinn says – weave your parachute every day, don’t wait until you have to jump out of the plane.
I have been lucky. I didn’t weave my parachute every day; I left some repairs until I needed it and almost ran out of time. But although I am still recovering from the fall, I landed in a much better place with my tool box still full.
In my introduction to part one I mentioned the possibility of healing pain. This is a huge topic in itself and one I will return to. Sometimes we can use meditation to heal pain, even if only temporary it gives us respite. Some types of pain can be completely healed when we let go of the tension in the body caused by fear, or resistance to what we are experiencing, since tension will make pain worse, or even produce pain as it causes us to tighten muscles.
Sometimes our healing is emotional, as we make peace with our pain. We can heal on many levels, not just the physical.
If you are in physical, emotional or psychological pain – or more likely a combination of these – then I can assure you that learning to meditate and live more mindfully will be a healing experience for you.
Some exercises to try:
Here I have included a few simple exercises followed by a complete meditation if you wish to try something more formal. These are all from my own experience but based on sound medical research.
1) Learn how to breathe. ‘I am breathing in, I am breathing out’ – repeat this and keep your focus only on your breath. It is simple and effective; allow your breathing to naturally slow and deepen if you are able and each time your mind wanders to anything other than your breath, gently bring it back. This exercise will encourage the Relaxation Response (see Dr. Herbert Benson) and the more you practise it the better.
NB: a difference between acute and chronic pain – acute pain can rarely be ‘got rid of’ using breathing techniques however the breath is a fantastic tool for coping with acute pain until it passes. I used only the breath when passing a kidney stone whilst giving birth to my 9lb plus son, so I can vouch for it working! Chronic pain occurs when the body becomes hypersensitive to pain so we can calm those receptors down and feel less pain using breathing and visualisation techniques.
2) Learn how to relax. Listen to music, watch the clouds, imagine warm sunlight being poured over your body from your head to your toes. Imagine sitting in a beautiful garden. Listen to guided meditations. Give yourself the gift of a little time to just be. Remember the saying ‘you are a human being, not a human doing.’
3) Learn how to sleep but also how to be awake. Learning how to sleep well is a huge part of feeling better but accepting being awake and being ok with it is also important. When you wake in the night use the time to practise your breathing or your body scans, remind yourself of anything you can be grateful for: a warm bed, clean water to drink etc., and be kind to yourself the next day. Punishing your body for keeping you awake the night before will not help.
4) Use affirmations. Tell yourself ten times each morning and evening something positive, e.g. ‘I am recovering’. You won’t believe it at first, but you will come to believe it and the mind is a powerful tool in our own healing or our own self-destruction. (See Dr. David R. Hamilton and Louise Hay).
5) If you can learn a healing light or a healing breath meditation use these whenever you are in acute pain. By breathing into the affected part of the body you increase the blood flow and by visualising healing taking place you release tension and reduce the pain and also encourage the healing proteins in your body to get to work. I use these for everything from headaches to joint pain to stomach spasms.
Making peace with pain meditation
This is a shorter, simpler version of a meditation I teach which is based on the work of Vidyamala Burch, Dr. David R. Hamilton and others.
First complete a breathing and relaxation exercise, just two to three minutes of centering and bringing your awareness to being in the present moment.
Allow a sense of kindness to come to your breathing...imagine it soothing the body as you breathe in and out…if you find that too difficult at first, simply breathe with the intention of kindness to your body…
Now just sit with whatever you are experiencing. Allow yourself to open to this experience...unpleasant experiences are an unavoidable part of life.
Then begin to breathe love and kindness into any areas of pain or discomfort...treat your pain as you would a child.
Bring to mind the part of your brain which deals with pain...at the moment it probably resembles a battle field...the place where you have been fighting your condition...there is no need to fight yourself any longer so imagine the battlefield being cleared...you could imagine beautiful light, warm gentle rain, a powerful but gentle wind, or anything that clears the whole area. Now the field is just a field, so you can begin to plant flowers...see the whole area turn into a beautiful garden...a place of healing and peace.
Allow that healing to grow with compassion for yourself...feel love and compassion flowing from your heart into every part of your body...imagine yourself loved, and as happy and healthy as you can be...
When this comes to a natural conclusion allow the images to fade, bring your attention back to your breathing and prepare to open your eyes. You may like to finish with an affirmation.
